Preservation of the superior rectal artery: influence of surgical technique on anastomotic healing and postoperative morbidity in laparoscopic sigmoidectomy for diverticular disease

Sohn, Maximilian; Hornung, Matthias; Zülke, C.; Hochrein, Alfred; Moser, Christian; Agha, Ayman

doi:10.1007/s00384-017-2792-x

Cited by 22 publications

(32 citation statements)

References 15 publications

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“…The methodological evaluation of the non‐RCTs with the MINORS scale showed that two studies scored 21 points (high quality) , two had 17 points and the other two studies scored 10 points (poor quality) (Appendix ). In the non‐RCTs there was a possible selection bias associated with the decision to preserve or to ligate the IMA.…”

Section: Resultsmentioning

confidence: 99%

“…The electronic search strategy identified 145 citations. After the initial screening of the titles and abstracts and removal of duplications, 58 titles remained, of which 15 were considered relevant [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. A total of eight studies met the inclusion criteria and were included in the analysis [16][17][18][19][20][21][22][23] and seven studies were excluded [24][25][26][27][28][29][30] (see Appendix S1 in the online Supporting Information).…”

Section: Results Of the Searchmentioning

confidence: 99%

“…The methodological evaluation of the non-RCTs with the MINORS scale showed that two studies scored 21 points (high quality) [18,19], two had 17 points [20,23] and the other two studies scored 10 points Table 1 Characteristics of studies included in the meta-analysis.…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…There was heterogeneity regarding the inclusion/exclusion criteria: three studies excluded the emergency setting [17,18,23] whereas in the other studies [19][20][21][22] some of the included patients had emergency resections (Appendix S5). The definition of anastomotic leakage (clinical versus radiological) was reported in five studies (Appendix S6).…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

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Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

et al. 2019

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Aim In colorectal cancer, ligation of the inferior mesenteric artery (IMA) is a standard surgical approach. In contrast, ligation of the IMA is not mandatory during treatment of diverticular disease. The object of this meta‐analysis was to assess if preservation of the IMA reduces the risk of anastomotic leakage. Method A search was performed up to August 2018 using the following electronic databases: MEDLINE/PubMed, ISI Web of Knowledge and Scopus. The measures of treatment effect utilized risk ratios for dichotomous variables with calculation of the 95% CI. Data analysis was performed using the meta‐analysis software Review Manager 5.3. Results Eight studies met the inclusion criteria and were included in the meta‐analysis: two randomized controlled trials (RCTs) and six non‐RCTs with 2190 patients (IMA preservation 1353, ligation 837). The rate of anastomotic leakage was higher in the IMA ligation group (6%) than the IMA preservation group (2.4%), but this difference was not statistically significant [risk ratio (RR) 0.59, 95% CI 0.26–1.33, I2 = 55%]. The conversion to laparotomy was significantly lower in the IMA ligation group (5.1%) than in the IMA preservation group (9%) (RR 1.74, 95% CI 1.14–2.65, I2 = 0%). Regarding the other outcomes (anastomotic bleeding, bowel injury and splenic damage), no significant differences between the two techniques were observed. Conclusion This meta‐analysis failed to demonstrate a statistically significant difference in the anastomotic leakage rate when comparing IMA preservation with IMA ligation. Thus, to date there is insufficient evidence to recommend the IMA‐preserving technique as mandatory in resection for left‐sided colonic diverticular disease.

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Section: Resultsmentioning

confidence: 99%

Section: Results Of the Searchmentioning

confidence: 99%

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

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Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

et al. 2019

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“…Sohn et al [12] Explicit definition: (1) clinically as manifestation with fever, septicemia and abdominal pain/peritonitis and/or extravasation of bowel content and/or gas through drainage or wound, confirmed by radiographic analysis or digital rectal examination or endoscopy, (2) evidence of local peritonitis and/or leakage of bowel content and/or gas from the anastomosis into the abdomen or pelvis within reoperation. Radiologic signs of anastomotic leakage were surrounding gas and/or fluid collection as well as extraluminal detection of contrast agent after enema.…”

Section: Author Definition Anastomotic Leakmentioning

confidence: 99%

Preservation of the superior rectal artery

Sohn

Agha

2017

coloproctology

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The sigmoidea ima artery: A player in colonic ischemia?

2020

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Introduction The sigmoidea ima artery is defined as the lowest sigmoid artery, which forms the distal end of the marginal artery by linking with the superior rectal artery. It supplies the rectosigmoid junction, which is a critical area for ischemia. The aim of the present study was to delineate the area supplied by the inferior mesenteric artery with special consideration of the sigmoidea ima artery. Materials and Methods The inferior mesenteric artery was dissected from its origin to the bifurcation of the superior rectal artery in 30 cadavers (15 male, 15 female). Vessel length and distance to the promontory were measured for each branch. Results There were two manifestations of the sigmoidea ima artery, irrespective of the branching pattern of the inferior mesenteric artery. It originated below the promontory in 25 cases (83.3%) and above it in three (10%). It did not derive from the superior rectal artery in two cases (6.7%). In these 16.7%, the marginal artery was absent near the rectosigmoid junction. Conclusions We suggest the terms “arteria sigmoidea ima pelvina” and “arteria sigmoidea ima abdominalis” for the two variants. The terms “arteria marginalis pelvina” and “arteria marginalis abdominalis” could be applied in clinical practice. An abdominal marginal artery could be considered a risk factor for colonic ischemia in colorectal resections and abdominal aortic aneurysm repair. Both variants should be considered when pre‐ and intra‐operative perfusion measurements are interpreted.

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Preservation of the superior rectal artery: influence of surgical technique on anastomotic healing and postoperative morbidity in laparoscopic sigmoidectomy for diverticular disease

Abstract: Preservation of the SRA seems to be associated with favorable outcome in patients undergoing laparoscopic sigmoid resection for diverticular disease.

Cited by 22 publications

References 15 publications

Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

Sigmoid resection for diverticular disease – to ligate or to preserve the inferior mesenteric artery? Results of a systematic review and meta‐analysis

Preservation of the superior rectal artery

The sigmoidea ima artery: A player in colonic ischemia?

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